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AP (2) > Exam 2 Lecture 8 (2-20-23) Pulmonary Introduction > Flashcards

Exam 2 Lecture 8 (2-20-23) Pulmonary Introduction Flashcards

1
Q

The cardiopulmonary system involves what two organs?

A

Lungs and Heart

(8:21)

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2
Q

What are the functions of the lungs mentioned in the lecture?

A
  • Gas-Exchange
  • Acid-Base Management
  • Some Metabolic Tasks
  • Blood Reservoir (Can hold up twice as much blood as it really needs/ can be diverted)
  • Location of Angiotensin Converting Enzymes (This is where ACE-inhibitors work)

(08:54)

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3
Q

The lungs will be located in the thorax separated by the membranous partition called the _____________.

A

mediastinum

(09:00)

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4
Q

How high do the apices of the lungs extend in our chest?

A

Pass the first rib, just above the clavicle.

This still baffles Dr. Schmidt.

(09:35)

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5
Q

The diaphragm is a ___________ muscle.

A

DIAPHRAGM IS A SKELETAL MUSCLE
DIAPHRAGM IS A SKELETAL MUSCLE
DIAPHRAGM IS A SKELETAL MUSCLE

(10:05)

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6
Q

What is the nerve that innervates the diaphragm?

A

Phrenic nerve

One phrenic nerve on the left diaphragm. One phrenic nerve on the right diaphragm.

(10:28)

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7
Q

What is the normal pressure of the chest in mmHg?

What is the normal pressure of the chest in cmH2O?

A

-4 mmHg

-5 cmH2O (This is what will be used to describe thoracic pressure in the pulmonary system)

(10:50)

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8
Q

What will thoracic pressure be during normal inspiration?

A

-7 cmH2O

(12:00)

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9
Q

How many lobes are in the right lung? Name the lobes.

How many lobes are in the left lung? Name the lobes.

A

Right Lung has 3 lobes. Superior, Middle, and Inferior Lobe.

Left Lung has 2 lobes. Superior and Inferior Lobe. (Less lobes in left lung, need space for the heart)

(12:45)

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10
Q

Name the connective tissue that sits on top of the lungs.

What is the second layer of connective tissue of the lungs called?

A

Visceral Pleura (visceral means organ, this layer sits on top of the lungs)

Parietal Pleura (outer layer of the lungs, sits on top of diaphragm)

(15:00)

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11
Q

What is the substance between the two connective tissues of the lung that allow the organ to glide along the chest wall?

A

Mucus

If we lose that mucus or if we get an infection and things start to be scratchy with these two surfaces, that can be very, very painful.

(15:26)

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12
Q

What pulmonary vessel is attached to the right ventricle?

A

Pulmonary Artery (Pulmonary Trunk)

(16:26)

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13
Q

What is the pulmonary hilum of the lungs?

A

The hilum of the lung is found on the medial aspect of each lung, and it is the only site of entrance or exit of structures associated with the lungs. They are a collection of the big arteries, veins, and airways.

(17:30)

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14
Q

What direction does the ribcage move during inspiration?

What direction does the diaphragm move during inspiration?

A

Ribcage elevates up during inspiration.

Diaphragm descends down during inspiration.

The movement of the ribcage and diaphragm will spread out the two lungs during inspiration.

(18:00)

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15
Q

A low lung volume to a high lung volume will result in a change of how many cm in lung height?

A

2 cm
(19:05)

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16
Q

What is the maximum amount of air the lungs can inspire after max exhalation?

A

The lungs can inspire a max of 4.5 L of air after a deep exhalation.

Lungs will increase in height by 2 cm and expand anteriorly during inspiration

(19:35)

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17
Q

What are the insertion points for the anterior diaphragm muscles?

What are the insertion points for the posterior diaphragm muscles?

A

The anterior diaphragm muscles have insertion points all the way around the base of the thorax and insertion points with the xiphoid process.

Insertion points of the posterior diaphragm are at the transverse process of L1. (right half of the diaphragm is situated more inferior than the left half.)

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18
Q

What tendon does the heart sit on?

A

Central Tendon

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19
Q

The diaphragm provides an airtight seal between what two regions in the body?

A

Thorax and Abdomen (23:35)

This seal needs to be airtight otherwise our pressure system for getting air in and out of the lungs isn’t going to work correctly.

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20
Q

What is the opening of the diaphragm for the esophagus called?

A

Esophageal Aperature
(24:00)

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21
Q

What is the opening of the diaphragm for the vena cava called?

A

Caval Aperature
(24:30)

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22
Q

What is the opening of the diaphragm for arterial blood called?

A

Aortic Aperature
(24:50)

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23
Q

Locate the Central Tendon
Caval Aperature
Aortic Aperature
Esophageal Aperature

A
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24
Q

Name the diaphragm apertures from most anterior to posterior.

A

Caval aperture (front)
Esophageal aperture (middle)
Aortic aperture (back)

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25
Q

What is the downside mentioned in the lecture about doing nerve blocks in the neck?

A

The phrenic nerves are close to the neck area. Too much anesthetic can knock out the phrenic nerve and interrupt respiration.

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26
Q

What are the accessory muscles fastened to the top of the thorax?

This muscle group connects from the thorax to the sides of the __________.

What is the purpose of this muscle group?

A

Scalene Muscle Group

Cervical Spine

Prevent the top of the thorax from being pulled down during diaphragm contraction during inspiration.

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27
Q

What cervical spine does the anterior scalene muscle (5) connect to?

What cervical spine does the middle scalene muscle (6) connect to?

Where cervical spine does the posterior scalene muscle (7) connect to?

A

Anterior (5): C3-C6

Middle (6): C3-C7

Posterior (7): C5-C7

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28
Q

Why are lung sounds heard better from the posterior side of the body rather than the anterior side of the body?

A

The bulk of the lung tissue is going to be located more posteriorly.

(32:00)

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29
Q

So if you switch someone’s orientation from supine to prone, that’s probably going to facilitate drainage of fluid out of the lungs and into the ________.

A

Heart
(33:30)

Due to the anatomical orientation of the tissues.

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30
Q

What is the largest part of our airway?

A

Trachea

(34:00)

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31
Q

The trachea splits off into the _______ and __________.

A

right mainstem and left mainstem

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32
Q

How many total airway segments are there in the right lung?

How many total airway segments are there in the left lung?

A

10 air segments on the right lung

8 airway segments on the left lung
The picture shows 10 airway segments for the left lung, but some segments are fused together.

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33
Q

What cartilage is between the thyroid cartilage and the trachea?

A

Cricoid Cartilage (37:00)

(Lower most cartilage of the voice box/larynx)

34
Q

What ligament fastens the thyroid cartilage and the cricoid cartilage?

A

Cricothyroid Ligament (38:00)

Typical place for an emergency invasive airway if intubation doesn’t work (Cricoidotomy). The thyroid gland gets in the way and may cause bleeding.

35
Q

What is the functional gas exchange unit in the lungs?

A

Alveolus/Alveoli (40:30)

Capillaries are in the walls alveolus to provide gas exchange.

36
Q

The conduits that connect the alveoli to each other are called _______.

A

Bronchioles

(41:25)

37
Q

Any place in the system where we have gas exchange happening is called __________.

Areas in the upper airways like the trachea and bronchi that do not have gas exchange are called __________.

A

Respiratory Areas
(Later parts of the bronchioles and the terminal end of the bronchioles.)

Conducting Zones or Conducting Airways.

(42:30)

38
Q

How many generations of conduction zones are there?

How many generations of respiratory zones are there?

A

17 Generations of conducting zones (Zone 0 to Zone 16) Confirmed by Dr. Schmidt

7 Generations of respiratory zones
(Zone 17 to Zone 23)

39
Q

How many split points are there in the conduction zone?

A

16 split points.

(43:50)

40
Q

What generation is the trachea in?

A

Generation 0

41
Q

What part of the airway starts in generation 1?

A

Brochi

Generation 1 to Generation 3

42
Q

Bronchioles in the conducting zone start in which generation?

A

Generation 4

Generation 4 to Generation 16
Needs Clarification

43
Q

Bronchioles in the respiratory zone start in which generation?

A

Generation 17

Generation 17 to Generation 19

44
Q

What is the smallest unit of the respiratory tree called?

A

Alveolar Sacs (Generation 23)

45
Q

What is another name for the conducting zone of the upper airways?

A

Anatomical Dead Space
(Generation 0 to Generation 16)

(46:00)

46
Q

How can you artificially reduce anatomical dead space?

A

Low Tracheostomy (47:30)

47
Q

This structure is known as a floating bone in the middle of the neck that connects to the voice box.

A

Hyoid Bone

(48:30)

48
Q

Locate the Hyoid Bone, Cricoidthyroid Ligament, Thyroid Cartilage, and Cricoid Cartilage.

A
49
Q

What structure is the question mark?

What does it do?

A

Epiglottis

This structure opens and closes when we swallow right. It directs food down the esophagus and out of the airways.

(49:00)

50
Q

Whenever we swallow food or liquid. What direction does the epiglottis travel and what direction does our voice box travel?

A

Epiglottis goes downward. Voicebox is pulled up by the hyoid bone. This is to ensure food travels down the esophagus.

(50:20)

51
Q

What kind of tension is needed on the vocal cords to produce a high pitch?

What about a low pitch?

A

High Tension = High Pitch

Low Tension = Low Pitch

52
Q

What is the approximant surface area for gas exchange in the lungs?

A

70 square meters
(the size of a tennis court)

(54:15)

53
Q

Performance limitation is always going to be in the ______ with someone who has healthy lungs.

A

heart

This means we can lose big chunks of our lungs and be fine because the heart is the limiting factor in cardiopulmonary function.

(55:10)

54
Q

Term for normal breathing.

A

Eupnea

55
Q

Term for uncomfortable breathing. Consciously becoming difficult to breathe.

A

Dyspnea

56
Q

Term for the absence of breathing.

A

Apnea

57
Q

Term that describes a type of noise heard from obstruction in the airway.

A

Stridor
Obstruction is usually from a tumor.

58
Q

What is bradypnea?

A

Slower than normal breathing rate.

59
Q

What is orthopnea?

A

Change in the ability to breathe when there is a change in position.

When we struggle to breathe when we flip over to our side is described as orthopnea.

60
Q

What is hyperpnea?

A

Higher ventilation than normal.
Hyperpnea refers to both rapid and deep breathing.

61
Q

What is hyperventilation?

A

Increased ventilation in excess of metabolic needs.

Hyperventilation is way more than we need for bodily functions.

62
Q

What is tachypnea?

A

Tachypnea refers to rapid, shallow breathing.

63
Q

What is hypoventilation?

A

Breathing less than we need for metabolic requirements.

64
Q

What is hyperinflation?

A

Lungs are too full of air and overinflation.
Think COPD

65
Q

Cyanosis is described as deoxyhemoglobin greater than _______.

A

5 g/dL

66
Q

Associate the color with the hemoglobin status.

Oxyhemoglobin

Deoxyhemoglobin

Lack of oxygenated hemoglobin and not in the form of deoxyghemoblin

A

Red

Dark Blue

Grey

(59:50)

67
Q

What is the decreased amount of O2 at the level of the tissue?

What is the decreased amount of O2 in the arterial blood?

A

Hypoxia

Hypoxemia

Dr. Schmidt will use these two terms interchangeably, but there is a difference between the two.

68
Q

Excessive CO2 in arterial blood.

A

Hypercarbia

CO2 greater than 45 mmHg

69
Q

Deficiency of CO2 in arterial blood.

A

Hypocapnia

CO2 less than 35 mmHg

70
Q

O2 levels above normal in tissues/organs.

A

Hyperoxia

71
Q

The term that describes the collapse of functional lung units.

A

Atelectasis

We can have atelectasis groups of alveoli or we can have atelectasis to maybe a whole lobe of the lung.

72
Q

The term describes the collapse of functional lung units.

A

Atelectasis

We can have atelectasis groups of alveoli or we can have atelectasis to maybe a whole lobe of the lung.

73
Q

Pulmonary Abbreviations

Pressure:

A

P

74
Q

Pulmonary Abbreviations

Blood Gas Content:

A

C

CaO2 - this is oxygen content in arterial blood

CaO2 = 20 mL of O2/ dL

75
Q

Pulmonary Abbreviations

Arterial:
Alveolar:

A

a (arterial)
PaO2-arterial PO2

A (alveolar)
PAO2- alveolar PO2

76
Q

Pulmonary Abbreviations:

Quantity per minute
Ventilation
Gas absorbed/expired per minute

A
77
Q

What are the units used to describe volumes of gas?

A

mL, cc, L, dL

78
Q

A number of individual volumes can be combined to become _______.

A

Capacities

A capacity is a combination of individual volumes.

79
Q

Formula for compliance

A

Change in Volume/ Change in Pressure

Describes how willing a container is going to accept more air, blood, or fluid.

80
Q

Formula for elastance

A

1/compliance

Change in Pressure/ Change in Volume

High elastance means low compliance and more rigidity.

AP (2) (5 decks)

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